Travel Assessment

If you are travelling abroad please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. To help the Travel Nurses assess your travel needs it is important that they are in receipt of the assessment form before your appointment. Please be aware that we require at least 6 weeks notice before you travel to allow time for your vaccinations. We regret we cannot guarantee the availability of appointments for ALL requests.

Last Updated: 01/03/2023

  • Your Details

    Please complete a separate form for each traveller

    Date of Birth
    For example, 15 3 1984

  • Trip Details

    Departure Date
    For example, 15 3 1984

  • Trip Description

    Purpose of Trip
    Type of Trip
    Accommodation

  • Please be aware

    Some travel vaccinations are not covered by the NHS and incur a charge

    I consent to the practice collection and storing my data from this form
    I consent to the Practice sending me text messages concerning my direct medical care
    I consent to the Practice sending me emails concerning my direct medical care and Practice information
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